Ketamine plus propofol-electroconvulsive therapy (ECT) transiently improves the antidepressant effects and the associated brain functional alterations in patients with propofol-ECT-resistant depression.
Jianjing Zhang, H. Tian, Jie Li, Shengzhang Ji, Suling Chen, Jingjing Zhu, Deguo Jiang, Lina Wang, Gongying Li, Min Chen, Wenqiang Wang, Xiaodong Lin, C. Zhuo
Psychiatry Research March 6, 2020 DOI: 10.1016/j.psychres.2020.112907 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 28 |
| Population | Patients with propofol-electroconvulsive therapy-resistant depression |
| Interventions | Ketamine Propofol-ECT |
| Duration | Two-week intervention, 7-day clinical follow-up, 10-day functional connectivity follow-up |
| Topics | Depression Esketamine Ketamine |
| Citations | 13 |
| Key findings | Adding ketamine to propofol-ECT improves short-term therapeutic outcomes in ECT-resistant depression, but the clinical effect lasts only 7 days, while brain functional changes persist for 10 days. |
Abstract
New methods for using ketamine in patients with propofol-electroconvulsive therapy-resistant depression (ECT-RD) are needed in the clinic. This study aimed to investigate the therapeutic efficacy of ketamine plus ECT in ECT-RD patients, along with the treatment-induced brain alterations. A total of 28 ECT-RD patients were intravenously injected with ketamine six times and treated with propofol-ECT six times alternately within two weeks. The Hamilton Depression Scale was used to assess the treatment effect. Global functional connectivity density (gFCD) and functional connectivity strength (FCS) were used to evaluate functional brain alterations. As compared with the propofol-ECT treatment group, the addition of ketamine could improve the therapeutic outcomes in patients with ECT-RD. The treatment increased gFCD in the left temporal and subgenual anterior cingulated cortex. Simultaneously, the treatment decreased FCS within the default mode network. Although increased functional connectivity could be sustained for 10 days, the clinical effect was only sustained 7 days, indicating that the clinical effect and functional brain alterations were disjointed. Ketamine plus propofol-ECT can obviously improve the effects of propofol-ECT in ECT-RD patients. However, the effect is limited in 7 days, suggesting the benefit is short-term.
Comparable studies
Other observational and cohort studies on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |
| Altered peripheral immune profiles in treatment-resistant depression: response to ketamine and prediction of treatment outcome Healthy controls and actively depressed patients with treatment-resistant depression... | 2017 | Observational cohort | n = 59 |
| Clinical Predictors of Ketamine Response in Treatment-Resistant Major Depression Treatment-resistant inpatients with DSM-IV-TR-diagnosed major depressive disorder or... | 2014 | Post hoc analysis of pooled data from four studies | n = 108 |
| An investigation of amino-acid neurotransmitters as potential predictors of clinical improvement to ketamine in depression Drug-free patients with major depressive disorder | 2011 | Observational cohort | n = 14 |
| Efficacy of ketamine therapy in the treatment of depression Drug-free/naïve men with severe depression, no history of psychotic disorder, head... | 2019 | Observational cohort | n = 25 |
Citations in the library
Cited by 6
- Real-world effectiveness of ketamine in treatment-resistant depression: A systematic review & meta-analysis. Journal of Psychiatric Research May 1, 2022
- Targeting metaplasticity mechanisms to promote sustained antidepressant actions. Molecular Psychiatry April 1, 2024
- Neuroimaging-Derived Biomarkers of the Antidepressant Effects of Ketamine Biological Psychiatry: Cognitive Neuroscience and Neuroimaging November 25, 2022
- Electroconvulsive therapy combined with esketamine improved depression through PI3K/AKT/GLT-1 pathway. Journal of Affective Disorders 2025
- Association of the delayed changes in glutamate levels and functional connectivity with the immediate network effects of S-ketamine Translational Psychiatry February 16, 2023
and 1 more in the library
Cites 13
- Double-Blind, Placebo-Controlled, Dose-Ranging Trial of Intravenous Ketamine as Adjunctive Therapy in Treatment-Resistant Depression (TRD) Molecular Psychiatry October 3, 2018
- Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial. American Journal of Psychiatry March 29, 2019
- Anatomical and functional investigation of the marmoset default mode network Nature Communications April 29, 2019
- Differential effects of rumination and distraction on ketamine induced modulation of resting state functional connectivity and reactivity of regions within the default-mode network Social Cognitive and Affective Neuroscience April 13, 2016
- Structural connectivity and response to ketamine therapy in major depression: A preliminary study. Journal of Affective Disorders January 15, 2016
and 8 more in the library